Platelet Transfusion Practices in Neonatology: A Single-Center Observational Study

Abstract

Background: Platelet transfusions are common in the neonatal intensive care unit (NICU), yet practices vary substantially. This study aims to determine platelet transfusion incidence, determinants, and justifications in neonatology.

Design and Methods: Single-centre prospective cohort study, including all patients consecutively admitted to the CHU Sainte-Justine Hospital NICU over a 5-month period in 2013. Data were collected by chart review and transfusion justifications were assessed using a questionnaire.

Results: A total of 401 participants were included. Mean birth weight (BW) was 2.34 ±1.01 kg and gestational age (GA) was 34.4 ±4.5 weeks. Thirty-seven neonates (9.2%) received at least one platelet transfusion. Platelet-transfused neonates were mostly extremely preterm (40,5%) or term (24.3%). The median pre-platelet transfusion count was 57 x 10⁹ /L (9 –285 x 10⁹ /L). Compared to non-transfused patients, those who received at least one platelet transfusion had a significantly lower BW and GA, higher CRIB-II and SNAPPE-II scores (all p<0.001) and were more frequently admitted for respiratory disease (p<0.001), hypoxic-ischemic encephalopathy (p=0.009) and haemolytic disease of the newborn (p<0.001). GA <28 weeks (p<0.001), mechanical ventilation requirements (p=0.008) and platelet nadir ≤150 x 10⁹ /L (p<0.001) upon admission were independently associated with a higher risk of platelet transfusion in this cohort. Most frequent justifications for ordering a first platelet transfusion were low platelet counts (86.5%), underlying disease (78.4%) and illness severity (37.8%).

Discussion: Pre-transfusion platelet counts in neonates varied widely and were higher than the thresholds proposed by available evidence. Several factors other than platelet count predicted risk of platelet transfusion in this cohort.

Note:
Funding Information: This research project was funded by a grant from the Fonds de la Recherche du Québec - Santé (Grant 24460).

Declaration of Interests: The authors have no conflict of interest to declare.

Ethics Approval Statement: The Research Ethics Board of CHU Sainte-Justine Hospital approved this study and waived consent.

Keywords: Platelet, Transfusion, Neonatology